diagnosis and treatment of psychopathology, class 2

DIAGNOSIS AND TREATMENT OF PSYCHOPATHOLOGY

Course: CED 5979Presenter: John Grady, LPC, LCADC, CCS, ACS, NCCClass #: Two

TODAY’S OBJECTIVES Checking in…

DSM 5 General Format

Diagnostic Report Assignment (Clinical Interview & Assessment)

Scheduling:

Treatment Team Presentations – DSM 5 Disorders

Case Study Presentations (fixed dates)

Tx Team Exercise

… Checking out (Summary)

QUESTIONS FOR THE CLASS“CHECKING IN…”

From DSM-5 text: The DSM-5 features a major structural change (the 1st since 1980’s DSM-III) – how does this affect counselors?

Some diagnostic thresholds have been lowered – what makes this important?

How can the following quote be helpful to clients?....

INSPIRATIONAL QUOTE

FORMAT:SECTION II – DIAGNOSTIC CRITERIA & CODES

There are 22 ”main categories” or “families of disorders” E.g. Neurodevelopmental Disorders

Under some “families”, we may (or may not) have a smaller group of similar disorders E.g. Intellectual disabilities; communication disorders

Under these clusters (or directly under the main category), we have specific disorders (i.e. those that have diagnostic codes) E.g. F88 Global Developmental Delay

(under Intellectual Disabilities)

E.g. F72 Social (Pragmatic) Communication Disorder (under Communication Disorders)

SO, WE HAVE …

22 large DSM 5 “Families”

Some “families” have divisions, each with specific

disorders (“Family Members”)

Most “families” do not have divisions, only the specific

disorders (“family members”)

DSM DISORDER “FAMILIES”

EXAMPLE: DSM-5 FORMAT, W/SMALLER

“GROUPS” Neurodevelopmental Disorders

Intellectual Disabilities

F88 Global Developmental Delay

F72 Intellectual Developmental Disorder, Severe

Communication Disorders

F80.89 Social (Pragmatic) Communication Disorder

EXAMPLE: DSM-5 FORMAT, W/O SMALLER

“GROUPS”Bipolar and Related

Disorders

F31.13 Bipolar I, current or most recent episode

manic, severe

F31.81 Bipolar II, current episode depressed,

moderate severity, with mixed features

HERE ARE THE DSM “FAMILIES” AGAIN…

IN EACH “FAMILY” ARE INDIV. DISORDERS (“MEMBERS”)

EACH “FAMILY MEMBER” HAS DIAGNOSTIC CRITERIA

STRUCTURE SUMMARY

Family (Group of Disorders) Family (Group of Disorders)

Divisions (some, not all)

Family Members (Specific Disorder) Family Members (Specific Disorder)

THAT’S ALL FOR NOW… Next week, we’ll talk about the specific diagnosis process

And screens that can help us

Let’s talk about the first step to gathering the information needed to diagnose –

The diagnostic interview

EFFECTIVE ASSESSMENTS One opinion: We are always assessing whenever in contact w/ct.

New information can be a new “puzzle piece” to explain client’s current condition

Attributes of semi & fully structured assessments Streamline info-gathering process Bolster credibility & validity of counseling process ID client motivation (Stages of Change) Clarify if challenges (i.e. pathology) exist ID client strengths, leisure, interests, etc. Create data to determine clinical needs, which helps us generate

relevant evidenced based interventions

ASSESSMENT FOCUS EXAMPLES

Behaviors General or specific (e.g. sleeping, substance use)

Personality/Affect Mood, emotions

Interpersonal Relationships Family, relationship themes, conflicts, strengths

Cognitive Thinking, awareness of reality

Physical Medical conditions (WHODAS 2.0)

Social & Multicultural Socioeconomic level, cultural beliefs, values

SUMMARY – INTERVIEW COMPONENTS (FOR DIAGNOSTIC REPORT & REFLECTION

ASSIGNMENT)

Mental Status Exam pgs. 135-138 in Seligman text For our project, only appearance, behavior, attitude, mood is required

Rest of components (below) are on pages 138-141

Identifying Info (e.g. age, gender)

Presenting Problem

Additional Problems & Previous Challenges

Present Life Situation

Family of Origin

Current Family

Developmental History

SUMMARY, CONT. Infancy

Early Childhood

Middle and Late Childhood

Adolescence

Adulthood

Medical and Counseling History and Treatments

Additional Info Important to Client

Assessment – which diagnosis is indicated given the presenting information (observed and reported)?

FOR THE DIAGNOSTIC REPORT & REFLECTION PAPER… Role play with your Tx Team partner or use w/ real client (if in

Practicum/Internship) Time will be provided next week (& the following if needed)

Gather the information outlined in previous slides Specific components are on pgs. 138-141 (Seligman text) You do not need to answer each question but generate good data Come to class prepared to ask questions of your partner

Assessment component (not in book) Consider which “family” of diagnoses might be indicated Identify a specific diagnosis if possible (give it some effort!) Do your best – this is an introductory exercise used to generate feedback

for you (& the class)

MENTAL STATUS EXAM COMPONENTS

Appearance Behavior Attitude Level of consciousness Orientation Speech & Language Mood Affect Thought Process Thought Content Suicidality and Judgement Attention Span Memory Intellectual Function

For our project, simply identify the components in red – more, if you wish

MSE, CONT.

MSE, CONT..

MSE, CONT.

QUESTIONS?

CASE STUDY SCHEDULING Week 13: Groups 1,2

Week 14: Groups 3, 4, 5

Week 15: Groups 6, 7

As we work in our groups, I will provide a sign up sheet for your group’s DSM 5 presentation…

Please put your TEAM # and your NAME on the sheet.

DSM 5 PRESENTATION SCHEDULING

As we work in our groups, please sign up for your DSM 5 presentation. Options include:

Anxiety Disorders

Mood Disorders

Gender Dysphoria

Trauma & Stressor Related Disorders

SA/Addiction Disorders

Obsessive Compulsive & Related Disorders

The dates are fixed, but you can choose your topic of interest

TX TEAM EXERCISE As you watch the clip, please put on your clinical cap and consider

the following: Appearance, Behavior, Attitude Presenting Problem (chief complaint) Present Life Situation (e.g. relationships, leisure) Key Symptoms

TONIGHT’S SUMMARY

Today’s important topic: DSM 5 General Format Clinical interview components

Upcoming Responsibilities: Prepare for interviewing your partner next week Read: Seligman Chapter 5

RESOURCESAmerica Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Washington, DC: Author.

Dailey, S.F., Karl, S.L., Gill, C.S., & Barrio-Minton, C.A. (2014). DSM-5 learning companion for counselors.

Alexandria, VA: American Counseling Association. 

Jongsma, A. E., Peterson, L.M., & Bruce, T.J. (2014). The complete adult psychotherapy treatment

planner (5th ed.). New York, NY: Wiley.

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The

Guilford Press.

Preston, J., & Johnson, J. (2015). Clinical psychopharmacology made ridiculously simple (8th ed.).

Miami, FL: MedMaster, Inc.